Pathogenesis and treatment of endometriosis: A systemic literature review

Endometriosis is a chronic gynecological disorder characterized by the abnormal growth of endometrial-like tissue outside the uterine cavity, leading to inflammation, pelvic pain, infertility, menstrual irregularities, and significant deterioration in the quality of life among affected women. Despite decades of clinical investigation, the exact pathogenesis of endometriosis remains incompletely understood due to its multifactorial nature involving hormonal imbalance, immune dysfunction, genetic susceptibility, inflammatory responses, environmental exposure, and altered cellular signaling mechanisms. This systematic literature review critically examines the current understanding of the biological mechanisms responsible for the initiation and progression of endometriosis while simultaneously evaluating contemporary therapeutic approaches used in its management. The review synthesizes evidence from recent clinical studies, experimental investigations, epidemiological analyses, and molecular research to identify the major pathogenic pathways associated with the disease. Findings from the literature indicate that retrograde menstruation alone cannot fully explain the development of endometriosis, and increasing evidence supports the combined role of estrogen dependency, chronic inflammatory activation, oxidative stress, angiogenesis, immune escape mechanisms, and epigenetic alterations in disease progression. The review further highlights the contribution of cytokines, growth factors, and abnormal immune cell activity in facilitating ectopic implantation and survival of endometrial tissues. In terms of treatment, the study evaluates both medical and surgical management strategies, including hormonal therapy, nonsteroidal anti-inflammatory drugs, gonadotropin-releasing hormone agonists, laparoscopic interventions, fertility-preserving approaches, and emerging targeted molecular therapies. The analysis reveals that although current treatments provide symptomatic relief and temporary disease suppression, recurrence rates remain considerably high, and long-term therapeutic outcomes continue to present clinical challenges. Furthermore, delays in diagnosis, variability in symptom presentation, and limitations in noninvasive diagnostic techniques significantly affect early disease management and patient prognosis. The review concludes that effective management of endometriosis requires an integrated multidisciplinary approach combining early diagnosis, personalized treatment planning, continuous monitoring, and advanced research into molecular-targeted therapies capable of improving long-term reproductive and clinical outcomes. The study emphasizes the urgent need for further translational research to better understand disease mechanisms and develop safer, more effective, and patient-centered therapeutic strategies for endometriosis management.